@article{HoermanndosSantosMorkischetal.2017, author = {H{\"o}rmann, Simon and dos Santos, Luara Ferreira and Morkisch, Nadine and Jettkowski, Katrin and Sillis, Moran and Devan, Hemakumar and Kanagasabai, Parimala S. and Schmidt, Henning and Kr{\"u}ger, J{\"o}rg and Dohle, Christian and Regenbrecht, Holger and Hale, Leigh and Cutfield, Nicholas J.}, title = {Computerised mirror therapy with Augmented Reflection Technology for early stroke rehabilitation}, series = {Disability and rehabilitation : an international, multidisciplinary journal}, volume = {39}, journal = {Disability and rehabilitation : an international, multidisciplinary journal}, publisher = {Routledge, Taylor \& Francis Group}, address = {Abingdon}, issn = {0963-8288}, doi = {10.1080/09638288.2017.1291765}, pages = {1503 -- 1514}, year = {2017}, abstract = {Purpose: New rehabilitation strategies for post-stroke upper limb rehabilitation employing visual stimulation show promising results, however, cost-efficient and clinically feasible ways to provide these interventions are still lacking. An integral step is to translate recent technological advances, such as in virtual and augmented reality, into therapeutic practice to improve outcomes for patients. This requires research on the adaptation of the technology for clinical use as well as on the appropriate guidelines and protocols for sustainable integration into therapeutic routines. Here, we present and evaluate a novel and affordable augmented reality system (Augmented Reflection Technology, ART) in combination with a validated mirror therapy protocol for upper limb rehabilitation after stroke. Results: The results showed that the combination and application of the Berlin Protocol for Mirror Therapy together with ART was feasible for clinical use. This combination was integrated into the therapeutic plan of subacute stroke patients at the two clinical locations where the second part of this research was conducted. Conclusions: Our findings pave the way for using technology to provide mirror therapy in clinical settings and show potential for the more effective use of inpatient time and enhanced recoveries for patients. IMPLICATIONS FOR REHABILITATION Computerised Mirror Therapy is feasible for clinical use Augmented Reflection Technology can be integrated as an adjunctive therapeutic intervention for subacute stroke patients in an inpatient setting Virtual Rehabilitation devices such as Augmented Reflection Technology have considerable potential to enhance stroke rehabilitation}, language = {en} } @article{MehnertBrunettiSteinbrinketal.2013, author = {Mehnert, Jan and Brunetti, Maddalena and Steinbrink, Jens and Niedeggen, Michael and Dohle, Christian}, title = {Effect of a mirror-like illusion on activation in the precuneus assessed with functional near-infrared spectroscopy}, series = {Journal of biomedical optics}, volume = {18}, journal = {Journal of biomedical optics}, number = {6}, publisher = {SPIE}, address = {Bellingham}, issn = {1083-3668}, doi = {10.1117/1.JBO.18.6.066001}, pages = {9}, year = {2013}, abstract = {Mirror therapy is a therapy to treat patients with pain syndromes or hemiparesis after stroke. However, the underlying neurophysiologic mechanisms are not clearly understood. In order to determine the effect of a mirror-like illusion (MIR) on brain activity using functional near-infrared spectroscopy, 20 healthy right-handed subjects were examined. A MIR was induced by a digital horizontal inversion of the subjects' filmed hand. Optodes were placed on the primary motor cortex (M1) and the occipito-parietal cortex (precuneus, PC). Regions of interest (ROI) were defined a priori based on previous results of similar studies and confirmed by the analysis of effect sizes. Analysis of variance of the ROI signal revealed a dissociated pattern: at the PC, the MIR caused a significant inversion of a hemispheric lateralization opposite to the perceived hand, independent of the moving hand. In contrast, activity in M1 showed lateralization opposite to the moving hand, but revealed no mirror effect. These findings extend our understanding on interhemispheric rivalry and indicate that a MIR is integrated into visuomotor coordination similar to normal view, irrespective of the hand that is actually performing the task. (C) 2013 Society of Photo-Optical Instrumentation Engineers (SPIE)}, language = {en} } @article{WangFritzschBernardingetal.2013, author = {Wang, Jing and Fritzsch, Claire and Bernarding, Johannes and Krause, Thomas and Mauritz, Karl-Heinz and Brunetti, Maddalena and Dohle, Christian}, title = {Cerebral activation evoked by the mirror illusion of the hand in stroke patients compared to normal subjects}, series = {Neurorehabilitation : an interdisciplinary journal}, volume = {33}, journal = {Neurorehabilitation : an interdisciplinary journal}, number = {4}, publisher = {IOS Press}, address = {Amsterdam}, issn = {1053-8135}, doi = {10.3233/NRE-130999}, pages = {593 -- 603}, year = {2013}, abstract = {BACKGROUND: Mirror therapy (MT) was found to improve motor function after stroke, but its neural mechanisms remain unclear, especially in single stroke patients. OBJECTIVES: The following imaging study was designed to compare brain activation patterns evoked by the mirror illusion in single stroke patients with normal subjects. METHODS: Fifteen normal volunteers and five stroke patients with severe arm paresis were recruited. Cerebral activations during movement mirroring by means of a video chain were recorded with functional magnetic resonance imaging (fMRI). Single-subject analysis was performed using SPM 8. RESULTS: For normal subjects, ten and thirteen subjects displayed lateralized cerebral activations evoked by the mirror illusion while moving their right and left hand respectively. The magnitude of this effect in the precuneus contralateral to the seen hand was not dependent on movement speed or subjective experience. Negative correlation of activation strength with age was found for the right hand only. The activation pattern in stroke patients is comparable to that of normal subjects and present in four out of five patients. CONCLUSIONS: In summary, the mirror illusion can elicit cerebral activation contralateral to the perceived hand in the majority of single normal subjects, but not in all of them. This is similar even in stroke patients with severe hemiparesis.}, language = {en} } @article{WangFritzschBernardingetal.2013, author = {Wang, Jing and Fritzsch, Claire and Bernarding, Johannes and Holtze, Susanne and Mauritz, Karl-Heinz and Brunetti, Maddalena and Dohle, Christian}, title = {A comparison of neural mechanisms in mirror therapy and movement observation therapy}, series = {Journal of rehabilitation medicine : official journal of the UEMS European Board of Physical and Rehabilitation Medicine}, volume = {45}, journal = {Journal of rehabilitation medicine : official journal of the UEMS European Board of Physical and Rehabilitation Medicine}, number = {4}, publisher = {Foundation for Rehabilitation Information}, address = {Uppsala}, issn = {1650-1977}, doi = {10.2340/16501977-1127}, pages = {410 -- 413}, year = {2013}, abstract = {Objective: To compare lateralized cerebral activations elicited during self-initiated movement mirroring and observation of movements. Subjects: A total of 15 right-handed healthy subjects, age range 22-56 years. Methods: Functional imaging study comparing movement mirroring with movement observation, in both hands, in an otherwise identical setting. Imaging data were analysed using statistical parametric mapping software, with significance threshold set at p<0.01 (false discovery rate) and a minimum cluster size of 20 voxels. Results: Movement mirroring induced additional activation in primary and higher-order visual areas strictly contralateral to the limb seen by the subject. There was no significant difference of brain activity when comparing movement observation of somebody else's right hand with left hand. Conclusion: Lateralized cerebral activations are elicited by inversion of visual feedback (movement mirroring), but not by movement observation.}, language = {en} } @unpublished{ThiemeMehrholzPohletal.2013, author = {Thieme, Holm and Mehrholz, Jan and Pohl, Marcus and Behrens, Johann and Dohle, Christian}, title = {Mirror therapy for improving motor function after stroke}, series = {Stroke : a journal of cerebral circulation}, volume = {44}, journal = {Stroke : a journal of cerebral circulation}, number = {1}, publisher = {Lippincott Williams \& Wilkins}, address = {Philadelphia}, issn = {0039-2499}, doi = {10.1161/STROKEAHA.112.673087}, pages = {E1 -- E2}, year = {2013}, language = {en} } @article{HeidlerSalzwedelJoebgesetal.2018, author = {Heidler, Maria-Dorothea and Salzwedel, Annett and J{\"o}bges, Michael and L{\"u}ck, Olaf and Dohle, Christian and Seifert, Michael and von Helden, Andrea and Hollweg, Wibke and V{\"o}ller, Heinz}, title = {Decannulation of tracheotomized patients after long-term mechanical ventilation - results of a prospective multicentric study in German neurological early rehabilitation hospitals}, series = {BMC Anesthesiology}, volume = {18}, journal = {BMC Anesthesiology}, publisher = {BMC}, address = {London}, issn = {1471-2253}, doi = {10.1186/s12871-018-0527-3}, pages = {7}, year = {2018}, abstract = {Background: In the course of neurological early rehabilitation, decannulation is attempted in tracheotomized patients after weaning due to its considerable prognostic significance. We aimed to identify predictors of a successful tracheostomy decannulation. Methods: From 09/2014 to 03/2016, 831 tracheotomized and weaned patients (65.4 +/- 12.9 years, 68\% male) were included consecutively in a prospective multicentric observation study. At admission, sociodemographic and clinical data (e.g. relevant neurological and internistic diseases, duration of mechanical ventilation, tracheotomy technique, and nutrition) as well as functional assessments (Coma Recovery Scale-Revised (CRS-R), Early Rehabilitation Barthel Index, Bogenhausener Dysphagia Score) were collected. Complications and the success of the decannulation procedure were documented at discharge. Results: Four hundred seventy patients (57\%) were decannulated. The probability of decannulation was significantly negatively associated with increasing age (OR 0.68 per SD = 12.9 years, p < 0.001), prolonged duration of mechanical ventilation (OR 0.57 per 33.2 days, p < 0.001) and complications. An oral diet (OR 3.80; p < 0.001) and a higher alertness at admission (OR 3.07 per 7.18 CRS-R points; p < 0.001) were positively associated. Conclusions: This study identified practically measurable predictors of decannulation, which in the future can be used for a decannulation prognosis and supply optimization at admission in the neurological early rehabilitation clinic.}, language = {en} } @article{UlmWohlrappMeinzeretal.2013, author = {Ulm, Lena and Wohlrapp, Dorota and Meinzer, Marcus and Steinicke, Robert and Schatz, Alexej and Denzler, Petra and Klehmet, Juliane and Dohle, Christian and Niedeggen, Michael and Meisel, Andreas and Winter, York}, title = {A circle-monitor for computerised assessment of visual neglect in peripersonal space}, series = {PLoS one}, volume = {8}, journal = {PLoS one}, number = {12}, publisher = {PLoS}, address = {San Fransisco}, issn = {1932-6203}, doi = {10.1371/journal.pone.0082892}, pages = {10}, year = {2013}, abstract = {Current assessment of visual neglect involves paper-and-pencil tests or computer-based tasks. Both have been criticised because of their lack of ecological validity as target stimuli can only be presented in a restricted visual range. This study examined the user-friendliness and diagnostic strength of a new "Circle-Monitor" (CM), which enlarges the range of the peripersonal space, in comparison to a standard paper-and-pencil test (Neglect-Test, NET). Methods: Ten stroke patients with neglect and ten age-matched healthy controls were examined by the NET and the CM test comprising of four subtests (Star Cancellation, Line Bisection, Dice Task, and Puzzle Test). Results: The acceptance of the CM in elderly controls and neglect patients was high. Participants rated the examination by CM as clear, safe and more enjoyable than NET. Healthy controls performed at ceiling on all subtests, without any systematic differences between the visual fields. Both NET and CM revealed significant differences between controls and patients in Line Bisection, Star Cancellation and visuo-constructive tasks (NET: Figure Copying, CM: Puzzle Test). Discriminant analyses revealed cross-validated assignment of patients and controls to groups was more precise when based on the CM (hit rate 90\%) as compared to the NET (hit rate 70\%). Conclusion: The CM proved to be a sensitive novel tool to diagnose visual neglect symptoms quickly and accurately with superior diagnostic validity compared to a standard neglect test while being well accepted by patients. Due to its upgradable functions the system may also be a valuable tool not only to test for non-visual neglect symptoms, but also to provide treatment and assess its outcome.}, language = {en} } @article{FritzschWangdosSantosetal.2014, author = {Fritzsch, Claire and Wang, Jing and dos Santos, Luara Ferreira and Mauritz, Karl-Heinz and Brunetti, Maddalena and Dohle, Christian}, title = {Different effects of the mirror illusion on motor and somatosensory processing}, series = {Restorative neurology and neuroscience}, volume = {32}, journal = {Restorative neurology and neuroscience}, number = {2}, publisher = {IOS Press}, address = {Amsterdam}, issn = {0922-6028}, doi = {10.3233/RNN-130343}, pages = {269 -- 280}, year = {2014}, abstract = {Purpose: Mirror therapy can improve motor and sensory functions, but effects of the mirror illusion on primary motor and somatosensory cortex could not be established consistently. Methods: Fifteen right handed healthy volunteers performed or observed a finger-thumb opposition task. Cerebral activations during normal movement (NOR), mirrored movement (MIR) and movement observation (OBS) by means of a video chain were recorded with functional magnetic resonance imaging (fMRI). Activation sizes in movement > static conditions were identified using SPM8 (p < 0.001, unc.) and attributed to predefined areas employing the Anatomy toolbox 1.8. Laterality indices for the responsive areas were calculated on the basis of the number of activated voxels. Results: Relevant bilateral BOLD responses were found in primary motor (M1) and somatosensory (S1 - BA 2, 3b and 3a) cortex, premotor and parietal areas and V5. When comparing MIR to NOR, no significant change of contralateral activation in M1 was found, but clearly at S1 with differences between hands. Conclusion: The mirror illusion does not elicit immediate changes in motor areas, yet there is a direct effect on somatosensory areas, especially for left hand movements. These results suggest different effects of mirror therapy on processing and rehabilitation of motor and sensory function.}, language = {en} } @article{FloeelWernerGrittneretal.2014, author = {Fl{\"o}el, Agnes and Werner, Cordula and Grittner, Ulrike and Hesse, Stefan and J{\"o}bges, Michael and Knauss, Janet and Seifert, Michael and Steinhagen-Thiessen, Elisabeth and Goevercin, Mehmet and Dohle, Christian and Fischer, Wolfgang and Schlieder, Regina and Nave, Alexander Heinrich and Meisel, Andreas and Ebinger, Martin and Wellwood, Ian}, title = {Physical fitness training in Subacute Stroke (PHYS-STROKE) - study protocol for a randomised controlled trial}, series = {Trials}, volume = {15}, journal = {Trials}, publisher = {BioMed Central}, address = {London}, issn = {1745-6215}, doi = {10.1186/1745-6215-15-45}, pages = {12}, year = {2014}, abstract = {Background: Given the rising number of strokes worldwide, and the large number of individuals left with disabilities after stroke, novel strategies to reduce disability, increase functions in the motor and the cognitive domains, and improve quality of life are of major importance. Physical activity is a promising intervention to address these challenges but, as yet, there is no study demonstrating definite outcomes. Our objective is to assess whether additional treatment in the form of physical fitness-based training for patients early after stroke will provide benefits in terms of functional outcomes, in particular gait speed and the Barthel Index (co-primary outcome measures) reflecting activities of daily living (ADL). We will gather secondary functional outcomes as well as mechanistic parameters in an exploratory approach. Methods/Design: Our phase III randomised controlled trial will recruit 215 adults with moderate to severe limitations of walking and ADL 5 to 45 days after stroke onset. Participants will be stratified for the prognostic variables of "centre", "age", and "stroke severity", and randomly assigned to one of two groups. The interventional group receives physical fitness training delivered as supported or unsupported treadmill training (cardiovascular active aerobic training; five times per week, over 4 weeks; each session 50 minutes; total of 20 additional physical fitness training sessions) in addition to standard rehabilitation treatment. The control intervention consists of relaxation sessions (non-cardiovascular active; five times per week week, over 4 weeks; each session 50 minutes) in addition to standard rehabilitation treatment. Co-primary efficacy endpoints will be gait speed (in m/s, 10 m walk) and the Barthel Index (100 points total) at 3 months post-stroke, compared to baseline measurements. Secondary outcomes include standard measures of quality of life, sleep and mood, cognition, arm function, maximal oxygen uptake, and cardiovascular risk factors including blood pressure, pulse, waist-to-hip ratio, markers of inflammation, immunity and the insulin-glucose pathway, lipid profile, and others. Discussion: The goal of this endpoint-blinded, phase III randomised controlled trial is to provide evidence to guide post-stroke physical fitness-based rehabilitation programmes, and to elucidate the mechanisms underlying this intervention.}, language = {en} }